To think the US paediatrician system is weird

[shaniahoo]

I'm on a few parenting groups that are American and the way they talk about their pediatrician is so alien to me. The ped seems to have a lot of power. Like, the hard line of these groups is that you always follow your ped's advice and nobody is allowed to question what a poster's pediatrician told them. But a lot of it seems like non-medical parenting advice? Everyone has their ped tell them when to start solids and they follow that - so they might tell you to start at 4 months so you do that or if they tell you to start at 6 months you do that. And everyone has to have their paediatrician "clear" their baby to start solids before they start. And the ped "clears" you to start sleep training or tells you you must do it or must not do it, and you do what they say. I suppose the equivalent here is the HV but you don't see them nearly so much and there's no sense among parents that you must do whatever your HV says.
AIBU to think this takes autonomy away from parents? Or is it great that they have so much advice and support?

@WMH You’re misunderstanding the system. Short-term disability payments are more like Statutory Maternity Payments (SMP) in the UK. Except they’re paid by an insurance company, not the government.

@HamBone Maternal death rates by country is shockingly high in the US. There has been a lot of research about it and it is due to poor or non existent pre and post natal care. Those with good insurance and ability to pay the co pays I am sure get good pre and post natal care, but those who do not have get very poor care.

I read for a long while a sub reddit of Drs in the US talking about their issues. One recurring issue was medical staff on the phone sometimes for hours to insurance companies pleading with insurers to authorise treatment that the Dr thought they should have. I always remember one Dr who was tearing his hair out because the insurance company who had never met the patient was insisting they would only authorise a cheaper cancer drug instead of the more expensive one the Dr said they needed.

There are real issues with the NHS. It has been purposely run down by our government and no proper provision made re Brexit that both means we have a real shortage of Drs and nurses. Any health system we have in Britain will have long delays for some routine treatments unless the shortage of staff is addressed.

...whether it's what actually happens or not...
Lol

@JarByTheDoor

It kinda matters that something actually happens or not. This is because if it doesn't happen the way you believe it happens, your umbrage here is misplaced.

I posted a relevant description of a typical teen visit to the pediatrician or gynecologist because your version of the scenario is frankly ridiculous.

Medical care in the US is delivered on a risk benefit basis, with cost of care in the case of adverse outcome from a condition that isn't investigated factored in, as well as the potential adverse outcome itself. If it made medical sense (and financial sense, because medical care has to be paid for by someone) to ignore the cervixes and STI status of sexually active teens until age 21, no doctor would administer the preventive care that is done. But the evidence says this is something that should be done when indicated, so it is done.

@MrsFinkelstein

The poster you're quoting wrt pelvic exam/ pill got it wrong.

@sashh

US pediatricians are trained and qualified to care for children to age 18 but can see patients beyond that if the patient needs continuity of care. Some pediatricians see their patients through their university years, to age 21-22.

Some parents choose to send a child to an OB/gyn instead for the teen years. But many stay with their pediatric practice. It's a matter of personal preference, and depends on health needs too - if a teen is pregnant she will have an OB/gyn. Many parents whose teens are involved in sport will go to a sports med doctor or will choose a pediatrician who sees a lot of teen athletes, maybe one whose practice employs physical therapists too.

Most pediatric practices will have several doctors and you might find one or two who specialize in teens, whether teen boys or teen girls, teens with psychiatric issues, etc..

@OutofEverything

I’m not disagreeing that some Americans have very poor healthcare. I’m saying that it varies tremendously depending on where you live.

I’ve lived here for over 10 years and the healthcare provisions where I’ve lived have been excellent. Obamacare has made a huge difference in terms of access to good healthcare in MY area, because our state is v. supportive of it and provides large subsidies.

If I lived in a v. rural area in a red state, however, it might be v. different.

That’s why it’s so difficult to compare the two countries, it’s really like comparing one country to an entire continent, because the US is so huge and culturally diverse.

But that’s not what they do. It’s been explained repeatedly on here what they actually do.

@HamBone That is reasonable. I do understand the different states operate almost like countries so there will be lots of variation.

Yes it makes more sense to compare the UK with other European countries that are closer in size and have national health care systems.

From the Guardian a few months ago:

UK has second highest maternal death rate in eight-country European study

Mothers in the UK are three times more likely to die around the time of pregnancy compared with those in Norway, according to an international analysis of data.

Researchers found that Slovakia had the highest maternal death rate among the countries studied. The UK had the second highest.

The findings come after a major review found that maternal mortality rates had risen in the UK.

The study, by an international team of researchers including academics from the University of Oxford, examined data on millions of live births across Denmark, Finland, France, Italy, the Netherlands, Norway, Slovakia and the UK.

I know. It's so much better to come on Mumsnet, at the end of your rope, and ask for advice from completely unqualified strangers than to have a conversation with a trusted medical professional who knows you and your child, their medical history from birth, and is completely conversant in the minutiae of developmental stages.

This is an aspect of the us susyem I'd much rather have.

It matters whether something happens or not, yes.

But it also matters if someone makes arguments justifying a bad thing happening, even when that bad thing isn't what happens in practice.

Making arguments in favour of bad things, using bad reasoning, is in and of itself worth challenging.

It's not "my version" of the scenario, it's the scenario that was presented in that comment chain. I was commenting on somebody who was arguing why that scenario would be okay, not your scenario, which means your description was irrelevant because your scenario wasn't the topic of that chain of discussion.

Are MNers really okay with leaving it to stand unchallenged, when a poster argues that it would be justifiable to tell women that they need an intimate exam to get the pill when they don't, because it would improve screening rates? I thought we were all about autonomy for women and informed choice.

Not to mention the racial disparities between women's maternal mortality rates within the UK.

Black women in UK four times more likely to die in pregnancy and childbirth.

www.theguardian.com/society/2021/nov/11/black-women-uk-maternal-mortality-rates

But why aren't there enough doctors in the UK? Why aren't doctors absolutely falling all over themselves to work within the NHS? If having the GP as the gatekeeper that rations out the healthcare is such a superior system then surely young medical students must be clamoring to get into the profession?

As an American I find this thread equal parts amusing and baffling.

Some posters seem to regard the NHS as the gold standard envied by the rest of the world. If that was ever true it surely isn't the case now. People are appalled by the long wait times, rationed services and the 1950's approach to preventative care and cancer screenings.

As to American healthcare, I think most of the world sees it as expensive and terribly inequitable (which it is). Those of us with excellent insurance (and let's face it - money) enjoy some of the best healthcare services on the planet while our less fortunate neighbors often make do with patchy care that is shameful in such a wealthy country.

Both of these systems are failing way too many people.

Thank you to everyone injecting facts and common sense to counter the ongoing misinformation about American health care.

On the Continent my friends are aghast at what they are reading and hearing about the NHS. We are in no position to criticise anyone

It is true that uninsured Americans are in a very tough spot (and I find that wrong) but otherwise the care I received through my HMOs there was a model of what a properly funded NHS could be. Only difference was the funding: employers with a small employee contribution.

I've no bits left to take to a gynaecologist, so that is in the past. Decades of skin cancer is still ongoing.

As I've said I work in a health related job and I am very familiar with the issues with the US system.

Having paediatricians handle children's primary care has nothing to do with our worse outcomes, and it's pretty easily provable because we're not the only country to do it this way. You can't assume that because the US has worse outcomes it means everything they do is wrong. As for what paediatricians do all day -- well visits aren't all they do (also the nurse actually gives the vaccines for example). It's like any routine primary care, only the patients are smaller and there's Disney characters painted on the wall of the exam room. Monitoring chronic conditions, lots of sick visits, injuries. But what I do like is that paediatricians have to develop a specific set of 'soft' skills - dealing with both their patients and their families. They have to learn how to communicate differently and talking to and educating parents is a significant part of their job.

Using the short-term disability system was a way of giving women paid leave while working with an existing framework. It isn't about declaring pregnancy a disability, it was just easy to do. In several states STD is a state run, mandatory programme so it was possible to give women some paid leave when the federal government wouldn't do it.

Yes, sure, that is all they do “99% of the time” 🙄 Why don’t you RTFT

It is definitely weird how Brits always compare the NHS to the US instead of to France, which is right next door, same size population, national system.

Until you realise French healthcare is so so so much better than the NHS, so of course people would rather not think about it.

I would love us to have a system a lot more akin to the French one

Given how hard it is to access effective medical care for children in the uk right now, anything is better.

maybe their paediatricians stray beyond their remit, but better that than have children caught between specialties, or just ignored and cared for badly.

The NHS is just the worst option right now.

US here and am again amazed at what some people think. My health and medical care has always been wonderful, including giving birth to my own children in a Deep South state (North Carolina) 30 years ago. Until I came to mumsnet, I had no idea that women had babies and slept in wards! With strangers, no less, sharing the space. And men visiting other women, sleeping in the same room! Even 30 years ago, every new mother labored and gave birth privately and was in a private room for her stay. The hospitals usually provide a “special” dinner, so the new parents can celebrate the new baby. Fathers usually get to stay, too. One of my friends works in labor/delivery in our large city public hospital(meaning that it serves everyone, from the poorist to those who are extreme high risk). Often, the doctors don’t even know who has insurance, who can pay, etc. it’s done through the billing department and the doctors don’t care. We have our faults, but women’s care is available to everyone, even the very poor, with no health insurance.

i have two cardiologists and a wonderful Ob/Gyn. I have a primary doctor (GP). Last time I needed a dermatologist, I picked one from my insurance company list, chosen by patient reviews, and did not require referrals for anything. Smears every other year, mammograms the years in between. Colonoscopy, every ten years. Dental, eye exams-all covered. The main thing here is, you have to make the appointment. Putting care off is the main reason for bad results. If you know you’re overdue for something, you have to make that appointment yourself, because they won’t come knocking on your door to ask you to come in.

I’ve used both system and I can’t agree more with you! You feel so vulnerable on a ward with male strangers visiting all the time. Very little privacy and quiet time and it’s pot luck who you neighbours are.

As an American, I'll say that there is plenty of ammunition if you're looking for legitimate criticism of the US. The system of using paediatricians as primary care for children is not remotely one of them.

Exactly this. I had two babies here (US) and can’t imagine what it would have been like to be on a ward with other mothers and their husbands. It was lovely to have a private room and the rest of our family were able to visit anytime without disturbing anyone else.